Understanding the barriers to circumcision in southern and eastern Africa

Deciding to undergo circumcision can be a long process. On average it takes men two years and three months from initially becoming aware of voluntary medical male circumcision (VMMC) to going through with the procedure, according to market research funded by the Bill & Melinda Gates Foundation in Zimbabwe and Zambia.

The research sought to better understand men’s behaviours and attitudes in relation to circumcision and what barriers and persuasive factors influence the uptake of this HIV prevention intervention – shown to be at least 60% effective in reducing HIV. 

Over 2,000 men and boys between the ages of 15 and 30 were surveyed in Zimbabwe and Zambia. They found that many men were aware of circumcision and often had the intent to do it, but after committing, anticipaticipation of the short-term effects of the procedure, stalls or stops their uptake. 

They found that men’s attitudes and questions about VMMC fell into five themes: sex appeal; the procedure; pain concerns; social support and the benefits. There was also marked differences in the path to VMMC according to age – with men taking longer to decide than boys.

Based on the findings, PSI Zimbabwe and the Society for Family Health, Zambia, were able to categorise men according to age, their attitudes towards VMMC, likelihood of uptake and ability to influence peers. 

Community workers mobilising demand for VMMC remarked that the categorisation helped them to better identify potential clients, and even though they were seeing fewer men, they had a higher conversion rate for VMMC. 

Since 2007, VMMC has been pushed by the World Health Organization (WHO), UNAIDS and PEPFAR, and especially in southern and eastern Africa, where 14 countries have initiated programmes.  But while initial uptake of VMMC was positive with around 12 million boys and men circumcised in these countries alone, this only constitutes 56% of the global target of 20.8 million circumcisions by 2016.

The findings, concepts and messaging from the programmes in Zambia and Zimbabwe are in the final stages of piloting, with the hope of scaling-up to inform more long-term VMMC programming across the region.